Onset in Shoulder?

DGret

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Male -Medicare age
Had a significant health scare in late 2020, which turned me into a health anxiety person.
Later on, developed nonspecific calf twitching. Has been present off anon for several months.
Saw my internist, normal exam.
Saw a neuromuscular ALS specialist last week.
Outcome: no clinical weakness at all
No hyperreflexia.
No pathologic reflexes.
Quote the consult report “ I heard nothing on history and saw nothing on examination to make me concerned that this man has either motor neuron disease or ALS. “
He did, however, in his exam, write “ there is subtle difference in muscle bulk between left and right shoulder.“

My question is, does new onset ALS start off with perhaps subtle atrophy, and no weakness? He did not call it atrophy, and tells me he doesn’t think I have ALS.

Thank you for your consideration. Ifesponding to this inquiry is a burden, then please don’t do so.

My hat is off to you for all you do.
 

lgelb

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Most of us are differenly sized from left to right in some areas. You have a dominant arm, do different activities with each arm, there is natural variation, etc. You have a result of which everyone here with ALS would be envious. No reason to worry. Calf twitching is very common and frequently responds to gentle stretches, massage, attention to sleep/nutrition/hydration, etc.

Re "being a health anxiety person," that could be something to work on, as it degrades your quality of life in the end, and likely that of those around you.

Best,
Laurie
 

DGret

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Thank you. I suspect there is a disuse component, relating to failed c-spine disk surgery many years ago.

Laurie - As you may see from my profile, I am a health professional, as I suspect you are.

So can I ask again, is this a mode of onset for ALS?
TYVM
 

Nikki J

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No. It is unusual for ALS to start proximally - not impossible but distal onset is much much more common. Even more so weakness precedes atrophy and you have identified a likely reason from your medical history that explains the difference in bulk.

you had an otherwise normal clinical exam with neither upper or lower motor neuron signs and the same person who commented on the bulk also said they had no suspicion of MND. They are an ALS specialist you said and to them the finding was insignificant. Is there a reason you do not trust their opinion?
 

lgelb

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What Nikki said...
 

affected

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No it's not. I hope you read the post you are directed to read before posting.
Continuing this with the terminally ill will not be productive nor appropriate now.
 

DGret

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Thanks to all. No distrust, simply that though I am a clinician, haven’t had much exposure to MND, and it’s various modes of onset.

Appreciation and regards/best wishes to all.
 

DGret

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One other question: I know there might not be full agreement on the fascicles and then weakness a long time later, and I have read the stickies.

Based on your expertise and experience, would you expect that after 8 months of fascics, either muscle failure, classical hand symptoms or clinical weakness would happen, or do you think that it could take longer (if the issue were ALS)?

Thanks, and best wishes to all!
 

Bestfriends14

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You've been cleared of ALS. Twitching means absolutely zero without clinical weakness. People don't twitch for eons and then suddenly lose muscle function in the case of ALS onset, nor do they have clean clinical exams, such as in your case.

I think this question has been beaten to death, though. You don't have ALS, so it's best to move on from a forum that's really design to answer a question or two for those who wonder about ALS, but mainly to support those who do have ALS, along with supporting their caregivers.

Good luck to you and take good care.
 

affected

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The sticky is our official position, read it, and take it as written.
You don't have ALS please don't expect the terminally ill to pander to your curiosity.
 

DGret

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Not pandering, legitimate question.

Peace. OUT.
 
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